STUDY GUIDE - PRENATAL & FETAL WELL BEING

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CH. 11:vocabulary

amenorrhea= absence of menstruation.
primary amenorrhea is a delay of first menstruation.
secondary amenorrhea is cessation of menstration
cillia= hairlike processes on the surface of a cell .
cilia beat rhythmically to move the cell or to move fluid or other substances over the cell surface
climacteric= physical & emotional changes occurring at the end of a women s reproductive period. also informally called menopause although this term does not encompass all changes
coitus=sexual union between a male & a female
fornix=(pl. fornices) an arch or pouchlike structure at the upper end of vagina. also called a cul-de-sac.
gamete= reproductive cell : in the female an ovum, & in the male a spermatozoon
genetic sex= sex determined at conception by union of two X chromosomes (female or xy male chromosome sex
gonad=reproductive (sex) gland that produces gametes & sex hormones.
the female gonads are ovaries male testes
gonadotropic hormones= secretions of the anterior pituitary gland that stimulate the gonads , specifically follicle-stimulating hormone & luteinzing hormone. chorionic gonadotropin is secreted by the by the placenta during pregancy
graafian follicle= a small sac with in the ovary that contains the mature ovum
menarche= onset of menstruation
menopause= permanent cessation of menstruation during the climacteric
puberty=period of sexual maturation accompanied by the development of secondary sex characteristics & the capacity to reproduce
ruga ridge or fold of tissue as on the males scrotum & in the females vagina
secondary sex characteristics= physical differences between mature males & females that are not directly related to reproduction
somatic sex= gender assignment as male or female on the basis of form & structure of the external genitalia
spermatogenesis= formation of male gametes (sperm) in the testes
spinnbarkeit= clear, slippery,stetchy quality of cervical mucus during ovulation

Review Table 11-1 Major Hormones in Reproduction

GONADOTROPIN-RELEASE HORMONE (GNRH)
hypothalamus /ANTERIOR PITUITARY
female= stimulates release of FSH & LH intiating puberty & pulsatile
male=stimulates release of FSH &LH ,initiating puberty
FOLLICLE-STIMULATING HORMONE (FSH)
anterior pituitary/ ovaries (female)/testies (male)
LUTEINIZING HORMONE (LH)
ESTROGEN = OVERIES/PLECENTA (PREGENCY)/BREASTS ACTIVATES MILK PRODUCTION
MALES /SM IN TESTIES NORMAL SPERM FORMATION
PROGESTERONE= OVARY,CORPUS LUTEUM,PLACENTA UTERUS,FEMALE
PROLACTIN= BREASTS /STIMULATES MILK
OXYTOCIN = UTERUS FEMALE BREST /UTERINE STIMULATS
TESTOSTERONE= SEXUAL ORGANS (MALE)
ADRENAL GLANDS (FEMALE) OVRIES

Review male & female anatomy, sperm & ova physiology

FEMALE )
EXTERNAL=
MONS PUBIS
LIBIA MAJOR/MINOR
CLITIRIS
VESTIBULE- ENCLOSED BY LABIA IT HOLDS URITINE MEATUS VAGINAL INTROITUS
PERINEUM IN BETWEEN V -ANUS
INTERNAL=
VAGINA
UTERUS
( COROUS/ FUNDUS),ISTHMUS,CERVIX, LAYERS OF UTERUS
PERIMETRIIUM=MOST POSTERIOR (EXTERNAL)
MYOMETRIUM=MIDDLE LAYER THICK MUSCLE
ENDOMETRIUM=( INNER )LAYER OF UTURINE
FALLOPIAN TUBES
OVARIES
PELVIS
MUSCLES
LIGAMENTS
BLOOD SUPPLY
NERVE SUPPLY
FEMALE REPRODUCIVE CYCLE
OVARIAN CYCLE =
FOLLICULAR PHASE= FIRST DAY OF OVUM MATURES BEGAINS FIRST DAY OF MENSTRUATION & ENDS ABOUT 14 DAYS LATER IN A 28 DAY CYCLE
OVULATORY PHASE= NEAR THE MIDDLE OF A 28 DAY REPRODUCTIVE CYCLE 2 DAYS BEFORE OVULATION
LUTEAL PHASE= AFTER OVULATION & UNDER INFLUANCE OF LH 12 DAYS
PRPLIFERATIVE PHASE= OVUM MATURE & RELSEASED DURING FIRST HALF OF OVARIAN CYCLE CAN GET PG
SECRETORY PHASE= UTERUS PREPRES
MENSTRUAL PHASE=FERTILIZATION DOSENT HAPPEN
FEMALE BREAST=STRUCTURE/FUNCTION
MALE EXTERNAL =
PENIS= URINATION/SPERM
SCROTUM= KEEP TESTIES COOLER
TESTIES= MALE GLANDS

CH. !2:CONCEPTION & PRENATAL DEVELOPMENT
vocabulary

AUTOSOME=ANY 22 PAIRS OF CHROMOSOMES OTHER THAN THE SEX CHROMOSOME
CONCEPTUS= cells &membranes resulting from fertilization of the ovum at any stage of prenatal development
CORPUS LUTEUM= graafian follicle cells remaining after ovulation these cells produce estrogen & progesterone
diploid having a pair of chromosomes (46 in humans) that represent one copy of every chromosome from each parent the number of chromosmes normally present in body cells other than gametes
EJACULATION=expulsion of sperm
EMBRYO= DEVELOPING BABY FROM THE BEGINNING OF 3 WK THROUGH THE 8TH E\WK AFTER CONCEPTION
ENDOMETRIUM= lining of uterus
FERTILIZATION AGE= prenatal age of the developing baby, calculated from the data of conception /postconceptional age
FETUS= DEVELOPING BABY 9 WKS after conception until birth
gamete= reproduction cell in the female an ovum & in the male a spermatozoon
gestational age = prenatal age of developing baby (measured in weeks, calculated from the 1st day of womens last period also about two wk longer then fertilization age
graafian follicle=small sac with in the ovary . the graafian follicle contains the maturing ovum
HAPLOID= having one copy of a chromsome from each pair 23 in humans or half the diploid number gametes normally have a haploid number of chromosomes
MEIOSIS= reduction cell division in gametes that halves the number of chromosomes in each cell
MITOSIS=cell division in body cells other than the gametes
NIDATION= implantation of the fertillized ovum (zygote) in uterine endometrum
OOGENESIS= formation of gametes ( ova ) in the female
OVULATION= RELEASE OF THE MATURE OVUM FROM OVARY
PLACENTA= fetal structure that provides nourishment to any removes wastes from the developing baby & SECRETES hormones necessary for the pg to continue
SEX CHROMOSOME= the X&Y cromesome
SOMATIC CELLS = body cells other than the gametes or germ cells
SPERMATOGENESIS= formation of male gametes (sperm0 in testies
TERATOGEN=an agent that can cause defects in a developing baby during pregancy
ZYGOTE=cell formed by union of an ovum & sperm

Process of conception, know where fertilization takes place (Figure 12-4).

Understand zygote versus embryo, when does the zygote become the embryo?
ZYGOTE FIRST TWO WEEKS ALL DNA / TRAVEL DOWN TO UTERINE
IMPLANTATION 2WK 6 - 10 DAYS
EMBRYONIC START AT 3 WEEKS TO 8 WEEKS take on specific functions /LIMBS /MAJOR ORGANS DEVELOPE
Review stages of fetal development, formation & function of placenta, maturation
hCG = HUMAN CHORIONIC GONADOTROPIN = PG TEST
UPPER UTERINE BEST TO IMPLANTATION
HEART BEGAN TO BEAT AFTER 21-22 DAYS

CH. 13: vocabulary

Review uterine growth pattern (Figure 13-1),
blood volume,= UTERINE GROWS SO BLOOD VOLUME
LATE PREGANCY BLOOD REACHES 450-650 ML/MIN NED FOR DELIVERY/FETAL GROWTH,REMOVEL OF METABOLIC WASTES
physiologic changes of pregnancy.
Identify
presumptive=
AMENORRHEA
NAUSEA& VOMITING
FATIGUE
FREQUNT URINATION
BREAST& SKIN CHANGES
VAGINAL & CERVICAL COLOR CHANGES ( CHADWICKS SIGN ( QUICKENING)
- probable=
ABDOMINAL ENLARGEMENT CERVICAL SOFTING (GOODELLS SIGN)
BALLOTTEMENT
BRAXTON HICKS CONTRACTIONS
PALPATION OF FETAL OUTLINE
UTERINE SUFFLE
PREGANCY TESTS
- positive signs of pregnancy=
AUSCULTATION OF FETAL HEART
FETAL MOVMENT FELT BY EXAMINER
VISUALIZATION OF FETUS
How to calculate EDD.=calculated based on the first day of your last menstrual period (LMP).
12 WEEK ABOVE PUBIC BONE
16 WEEKS FUDUS BETWEEN PUBIC AND UMBILICUS
LOCTED AT 20 WK AT UMBILICUS
Identify major tasks of prenatal care by trimester.
FIRST TRIMESTER
ASSESS TO IDENTIFY PROBLEMS
EDUCATE
CONCULING & SOCIAL SUPORT
INITIAL VISIT
HISTORY
GTPAL
G= PREGANCYS
T= TERM BITH
P= PRETERM
A=ABORTION
L= LIVING CHILDREN
MENSTRUL HISTERY= DUE DATE ) FIRST DAY OF LAST PERIOD
MED SUG HISTORY
FAMILY HISTORY
PHYSICAL EXAMINATION
VITALS
URINE SAMPLE= PROTEIN/GLUCOSE/KETONES/BAC
BREASTS/NIPPLES
INTERNAL ORGANS

Review danger signs of pregnancy (p. 274),=
VAGINAL BLEEDING WITH OR WITH OUT CRAMPS
RUPURE OF MOMBRANES ( ESCAPE OF FLUID FROM THE VAGINA )
SWELLING OF FINGERS OR PUFFNESS IN FACE OR AROUND EYES
POUNDING HREAD ACHES
BLURID VISION, SPOTS
ABDOMAL PAIN
CHILLS FEVER
PAINFUL URINATION
PERSISTENT VOMITING
CHANGE IN FETAL MOVMENT
SIGNS OF PRETERM LABOR

common discomforts of pregnancy=
NAUSEA& VOMITING
HEART BURN
BACKACHES
ROUND LIGAMENTS PAIN
URINARY FREQUENCY
VARICOSITIES
HEMORRHOIDS
CONSTIPATION
LEG CRAMPS

CH. 14: vocabulary

Review by trimester the psychological changes of pregnancy=,
1 ST TRIMESTER= UNCERTAINTY WHEN THEY FIND OUT OF PG
PG CAN BE A SUPRIZE MOM USUALY FOCUS ON SELF
2 TRIMESTER PG BECOMES REAL BREAST CHANGE MOVMET IS FELT OTROSOUND/ NOLONG A PART OF HER IT IT SELF
FETUS PRIME FOCUS
NARCISSISM&INTROVERSION = CONCERN ABOUT THE ABILITY TO PROVIDE AND PROTECT FETUS (EATING RIGHTRT CLOTH
PRIMIGRAVIDA= WONDERS WHAT IFANT LOOK LIKE (LOOKS AT PHOTOS )
BODY IMAGE
CHANGES IN SEXUALITY
3 TRIMESTER=
VULNERABILITY= MAY RELAY ON PARTNER
INCREASE DEPENDENCE
DURING LAST WKS OF PREGANCY MAYBE COME CONCERN WITH DELIVERY FEAR LABOR DREAD DUE DATE WHILE OTHER LOOK FORWARD TO DUE DATE
FIRST TIME FEAR BIRTH MORE

maternal role transition.=
BEGAINS DURING PG INCREASES W GESTATINAL AGE
MUST ACCEPT PG/CHANGES
MUST DEVELOPE RELATONSHIP WITH FETUS
MUST PREPARE SELF FOR BIRTH & PARENTING
STEPS
MIMICRY=
ROLE PLAY
FANTASY
LOOKING FOR A ROLE FIT
GRIEF WORK

Review cultural beliefs related to pregnancy=
EACH PERSON HAS THERE OWN BELIEFS
. Nursing implications.= LOCATE INTERPITOR
AVOID LABLING BELIFES REINFIRCE THAT PREMOTE A GOOD PREGANCY OUTCOME
ELICT HELP FROM ACCEPTED SOURCES OF INFORMATON TO OVERCOME HARMFUL PRACTICES

Review proper timing of childbirth education=
MANY CLASESS AVAVILBLE FOR PG WOMEN
EARY PG CLASSES EMPHASIZES HAVING A HEALTHY PREGANCY
LATE PG FOCUSE ON PREPARING FOR BIRTH BREASTFEEDING,PARENTING

CH. 15: vocabulary

Recommended weight gain (Table 15-1).
determined weight & height or (BMI)
normal weight gained total =11.5-16 lb/first=3-5 lb weekly gain0.88lb
underweight=total =28-40 lb/first=3-5 lb/1.1 wk 2&3 trimester
overweight =total=15-25lb/first/2lb/2&3 wk=.66lb
obease=total/15lb/idivulized
twin pregancy=total/35-45lb/first3.5lb/week 2&3 tri 1.5 lb
Vitamin & mineral needs and sources.
vitamins A=( sources) vegs( dark green,yellow,orange)lowfat nonfat,milk,
(purpose) importent vision cell repair growth .fuction of skin/mucus membrane
inportentce of pg = fetal growth /to much causes spontsneous abortion /fetal defects (dont take whiler pg !!)
vitamin D= milk margarine soy products,butter,egg yolks
sunlight not enough cause infant to hypocalcemia issue tooth enamel
to much hypercalcemia & posibble fetal deformities
vitamine E=veg oil whole grains nuts,& dark green leafy veg/rearly deficient could cause enemia
vitamin k=dark green leafy veg one dose given after birth
WATER SOULBLE
Vitamines B6 = chicken, fish,pork,eggs,peanuts,whole grain, cereal/ increased metabolism of amino acids during pregancy
vitaminsB12= meat fish eggs,milk forified soy & cereral increase formation of RBC
folic acid dark green leafy vegs, beans,peanuts,orange juice.asperagus,spinach,pasta( Dont cook)/up blood level tissue growth deficiency in first week may cause spontanious abortion
vitamin C= friuts ,barries, vegs tomatos potatos,/ need for fetus formation tissue exp people who smoke , drink

minerasls
iron =meat dark green leafy vegs eggs grains /up volume of blood store in fetal liver
calcium=dairy,salmon w juice ,tofu, broccoli/ minerlization of fetal bones teeth
zinc meats ,poultry seafood eggs nuts,seeds,/ fetal & maternal tissue growth

Ch. 16:

Prenatal testing & timing during pregnancy.
ulrasonography =
emotional responses please or fearful
first trimester= vaginal ) determine pg/featal heart beat
detecting multifetal gestations. age,comfirming fetal
identify needs for follow- up testing/abnormalities
second & third trimester
abdomen
comfirm fetal viability, anatomy,age,measure growth
measure amniotic fluid volume
location of placena
sex fetus
doppler look at the vessels /blood flow
complications/hypertention
ALPHA-FETOPROTEIN SCREENING
IS THE MAIN PROTEN IN FETAL PLASMA
diffuses from fetal plasma to fetal urine detectice serious fetal abnormalities
trisomy 21 (down sydrome)
most common anterior body wal dosent close

Understand 'triple-marker screening' =
human chorionic gonadotropin (hCG)
unconjugate estriol both chromosome abnormilies detection
like trisomy 18 &trisomy 21 ( 16 - 18 week)
and information required when test is processed - (fetal gestational age!).
Understand risk/benefit & nursing implications for invasive prenatal tests including

amniocentesis & chorionic villus sampling.= suport of pt and get DR> involved

Basic fetal monitoring tests such as non-stress test and why we do them? cheak fetus moves, oxygetaion , fetus heart beat w stimulation test for infection
Review biophysical profile=asess five parameters of fetal well-being fetal breaths,growth,movment,fetal tone,amonic fluid volume
. Maternal fetal movement counts.
(kick conts)10 movment in 12 hr/2 movment /60 min

CH/ 18:
Review Table 18-1. Understand fetal position & assessment using Leopold's maneuvers

Leopolds maneuvers to identify the fetal back
closest to surface /fetal heart sounds are clearest

Forms of contraception- Chapter 10, and pages 186-7, Table 10-1

sterillization
progestin implant=3 YR
progestin injection = EVERY 12 WKS
oral contraceptives= EVERYDAY
emergency contraception (EC)= MUST BE TAKEN W/IN 120 HRS
transdermal patch- one wk appilcation/reg period
vaginal contracepive ring- in place for three wk at time
intrauterine devices (IUDS) -5-10 YRS

BARRIERS
CHEMICAL = SPERICIDE ONE TIME USE
CONDOMS= BEST PRTECTION AGENST STDs
SPONGE= MUST REMAIN IN PLACE 6HE AFTER SEX NO MORE THEN 30 HRS
Diaphragm= CAN STAY FOR 24 HRS
cervical cap = SM 48 HRS

NATURAL FAMILY PLANNING

Contraindications for oral contraception =SHOULD NOT BE TAKENED IF PT HAS HISTORY OF
BLOOD CLOTS
CEREBROVASCULAR & CARDIOVASCULAR DISEASE
ANY ESTERGEN-DEPENDENT CANCER OR BREAST CANCER
BENIGN OR MALIGNANT LIVER TUMORS
HYPERTENTION ( UNLESS WELL CONTROLLED BY MEDICATION )
MIGRAINES
DIABETIES

IMPARED LIVER
SUSPECTED OR KNOWN PG
UNDIGNOSISED VAGINAL BLEEDING
SMOKERS
OLDER 35
MAJOR SURGERY PROLONG IMMOBILIZATION

Reproductive Anatomy - Chapter 11 and pages 219, Table 11-1

GONADOTROPIN-RELEASE HORMONE ( GnRH)
Hypothalamus ,Anterior pituitary =
( women) stimulates release of FSH & LH intitating puberty & sustaines female reproductive
(men) stimulates releaseof FSH &LH initiating puberty
FOLLICLE-STIMUATING HORMONE (FSH)
anterior pituitary overies &testies
stimulates final matruty of follical
stimulates growth & maturation of graafin follicles before ovulation
(men)= stimulates leydig cells of testes to secreate testosterone
estergen &progestergen
prolactin
oxytocin
testoserone

Conception cycles - pages 225-7, Figure 11-7

(follicular phase >ovulation > luteal phase )
1-8mesteral phase> 8-14 proliferative phase>14-16day ovulation>16-20secretory phase> 24-28 Ischenic phase>menstrul phase

Cycles of Pregnancy- Chapter 12 and pages 232-249,

embreo 3 wk
fetus at 9 wks

Maternal changes during pregnancy - Chapter 13 and pages 251-257

...

OB History - GTPAL - p 262

...GTPAL
G= PREGANCYS
T= TERM BITH
P= PRETERM
A=ABORTION
L= LIVING CHILDREN

Access Gateway Library online/ videos/ for videos about Mitosis/ Meiosis

...

page 230)

Mitosis- Cell division in body cells other than the gametes

" (page 230-231) Page 232 Figure 12.1

Meiosis -Reduction cell division in gametes that halves the number of chromosomes in each cell (so that father and mother each contribute ½ of the baby's genetic makeup) - so each parent can say "He has 'mei'

Access Prenatal - birth video

...

Terms
Embryo -

...1st 8 weeks of gestational life

Fetus -

...8weeks to birth

Placenta -

...provides nutrients and processes waste for fetus - the lifeline

Know how to determine due date

first day of you period

Fetal development milestones: page 236 - Table 12.2

...

Day 25 -

heartbeat

3 months/ end of first trimester - .

organs are formed

...

Fetal nourishment/ prenatal diet and nutrition =
nutrient needs during pg increase to meet the demands of the mother & fetus
68000&80000 cal are need during pg
protein is needed
vitamins not realy needed

Maternal blood volume increases about 50% during pregnancy.
Rh- mother with 2nd pregnancy and later is at highest risk for Rh incompatibility

Vena Cava Syndrome - supine hypotension. Page 254, Figure 13.4

...supine hypotensive syndrome= when women is supine the weight of the gravid uterus partially occludes the vena cava & the descending aorta ( lateral recumbent position corrects supine hypotention

Danger signs during pregnancy - page 274

vagina bleeding w /wo dicomfort
rupture of membrance
swelling of fingers face
contunius pounding headache
visual issues
abdominal pain
chills&fever
painful urination
presistant vomiting
change in fetal movement
preterm labor

High Risk factors in Pregnancy - page 267, Box 13.3

demographic factors
under 16 yr or over 35 yrs =increase risk preterm labor preeclampsia
low income familys= low birth weight preterm labor
increase risk of maternal death
multiparity>4 =incress risk of loss/postpartum hemorrhage,c-section

social -personal factors=
low pg weight = low birth weight
obease= increase risk for preeclampsia, difficult, labor,lg infant,c-section
smoking = spontanious abortion / low birthweight/preterm birth,increase infant mortality
alcohol drugs= with draw syndrome, fetal alchol sydrume
obstetric factor= birth of previos 8.8 lb =risk for c-section birth injury,diabeties,
previous fetal death=mom distress
RH FACTER= fetal anemia
existiing medical condition
diabeties= increase risk for diabeties,c-section. sm lg baby
throid disorder= miscarrage
hyper thiroyd= preeclapcia. post hemerrage
cardiac disease= increase risk of death infanyt death
renal diseae= mom renal failure preterm dilvery
concurrent infection= infant blindness,deafness,bone issues miscarrage

Common Lab tests during pregnancy - page 268, Table 13.1

blood groupion =rh factor
hemaglobin& hematocrit =anaemia
cbc=i dentify infection
rubella titer= immune
test hiv
heb- B
PAP TEST = CANCER
CERVERCAL CULTURE- SRTEP B
MULTPLE MARKER = FETAL ABNORMALITIES
GLUCOSE CHALLANGE TEST =GESTATION DIABETIES

Assessments during pregnancy - pages 268-270.

vitals
weight 25-35 lb
urinalysis = each vist test ,protein,,glucose,ketones, bac,history of utis dipstic for nitrates
fundul hight
leopolds maneuvers=palpating fetus
fetal heart rate (doppler)
fetal activity 16-20 around time feel infant move
waring signs = labor
ulterlsound
glucose screening 28 weeks
isoimmunization= antibody test women who r RH- recive anti D immune globin (RhoGAM)
pelvic exame= any changes

adaptation - Chapter 14 - maternal responses and cultural influences - page 289-91

...Factors that influence maternal psychosocial
age= teen or 40
multiparity = usual much more challaging
social suport=partner ,family friends
absence of partner=finatual emotional support ,poor, medicade,WIC
social econmic status= resorces avalible to familys
abnormal situations= abuse,depression
culteral influcence=can create major conflicts between expected families heath care language,time oritation,health belifes

Prenatal care - Nutrition for Childbearing - chapter 15 and
Recommended Weight Gain during pregnancy - page 289, Table 15.1

normal weight gained total =11.5-16 lb/first=3-5 lb weekly gain0.88lb
underweight=total =28-40 lb/first=3-5 lb/1.1 wk 2&3 trimester
overweight =total=15-25lb/first/2lb/2&3 wk=.66lb
obease=total/15lb/idivulized
twin pregancy=total/35-45lb/first3.5lb/week 2&3 tri 1.5 lb

Nutritional Needs - page 390, Table 15.2 and pages 302-303,. Table 15.3

vitamins A=( sources) vegs( dark green,yellow,orange)lowfat nonfat,milk,
(purpose) importent vision cell repair growth .fuction of skin/mucus membrane
inportentce of pg = fetal growth /to much causes spontsneous abortion /fetal defects (dont take whiler pg !!)
vitamin D= milk margarine soy products,butter,egg yolks
sunlight not enough cause infant to hypocalcemia issue tooth enamel
to much hypercalcemia & posibble fetal deformities
vitamine E=veg oil whole grains nuts,& dark green leafy veg/rearly deficient could cause enemia
vitamin k=dark green leafy veg one dose given after birth
WATER SOULBLE
Vitamines B6 = chicken, fish,pork,eggs,peanuts,whole grain, cereal/ increased metabolism of amino acids during pregancy
vitaminsB12= meat fish eggs,milk forified soy & cereral increase formation of RBC
folic acid dark green leafy vegs, beans,peanuts,orange juice.asperagus,spinach,pasta( Dont cook)/up blood level tissue growth deficiency in first week may cause spontanious abortion
vitamin C= friuts ,barries, vegs tomatos potatos,/ need for fetus formation tissue exp people who smoke , drink

minerasls
iron =meat dark green leafy vegs eggs grains /up volume of blood store in fetal liver
calcium=dairy,salmon w juice ,tofu, broccoli/ minerlization of fetal bones teeth
zinc meats ,poultry seafood eggs nuts,seeds,/ fetal & maternal tissue growth

Dietary Guidelines/ nutritional contents of foods - page 304-7.

whole grain 7 serving
vegs=5 sevings
fruits 4 servings
dairy=3 servings
protein rich foods 7 servings
fats & oils=2 servings

Foods for lactating mothers and special needs - page 310-16

whole garin 7 servings
veg 5 servings
fruits 4 servings
calcium- rich foods 8 servings
protein-rich 7 seving (pg) 8 (lac)
B12 rich foods 4 servings
fat & oils 2 servings

Prenatal Tests - Chapter 16 and page 322, Box 16.2, Indications for Disgnostic Procedures, and tests pages 322-333 - tests, why and when they are done, what do they show. (E.g. AFP, CVS, Amniocentesis)

...ulrasonography =
emotional responses please or fearful
first trimester= vaginal ) determine pg/featal heart beat
detecting multifetal gestations. age,comfirming fetal
identify needs for follow- up testing/abnormalities
second & third trimester
abdomen
comfirm fetal viability, anatomy,age,measure growth
measure amniotic fluid volume
location of placena
sex fetus
doppler look at the vessels /blood flow
complications/hypertention
ALPHA-FETOPROTEIN SCREENING
IS THE MAIN PROTEN IN FETAL PLASMA
diffuses from fetal plasma to fetal urine detectice serious fetal abnormalities
trisomy 21 (down sydrome)
most common anterior body wal dosent close

Understand 'triple-marker screening' =
human chorionic gonadotropin (hCG)
unconjugate estriol both chromosome abnormilies detection
like trisomy 18 &trisomy 21 ( 16 - 18 week)
and information required when test is processed - (fetal gestational age!).
Understand risk/benefit & nursing implications for invasive prenatal tests including

amniocentesis & chorionic villus sampling.= suport of pt and get DR> involved

Basic fetal monitoring tests such as non-stress test and why we do them? cheak fetus moves, oxygetaion , fetus heart beat w stimulation test for infection
Review biophysical profile=asess five parameters of fetal well-being fetal breaths,growth,movment,fetal tone,amonic fluid volume
. Maternal fetal movement counts.
(kick conts)10 movment in 12 hr/2 movment /60 min

http://www.youtube.com/watch?v=bSEsFQ2Z3HI - you tuve video about labs and tests -very good.

...

http://www.youtube.com/watch?v=SUXMfQ9nYrY - you tube on dating a pregnancy - really good.

...

Chorionic villus sampling

Chorionic villus sampling is a test performed during 10 and 12 weeks of pregnancy to provide vital information about developing fetus. A sample of the chorionic villi is taken from the placenta. It can be done transabdominal or transcervical. The benefit of this test is detection of genetic or chromosome disorders. Chorionic villus sampling is able to detect Down syndrome, cystic fibrosis, Tay Sachs, and other conditions. Risks of chorionic villus sampling are miscarriage (1 in 100), which is greater risk if the sampling is done transcervical. RH sensitization, and uterine infection are also risks. This test is recommended for women 35 and older, prior histories of positive chorionic villus sampling, and family history of prior chromosomal or genetic disorders. RH negative mothers that are sensitized are cautioned and physician may advise against the test due to increased complicatons

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A well balanced diet is not only important for the baby, but the mother as well. Following the American food pyramid is a great way to get a variety vitamins, fiber, and protein from everyday eating. It's highly recommended that a daily prenatal vitamin is taken to supplement the body.

Iron is important for pregnant woman as they can become anemic from diluted red blood cells. An iron supplement, red meats, spinach all are suggested to get at least 27 mg of iron.

1000-1300 mg of calcium is the suggested amount for a pregnant woman, 70 mg of vitamin C a day and at least 0.4 mg of folic acid daily to helps prevent some defects.

Decreased mobility in the large intestine increases water absorption and can lead to constipation. Drinking plenty of water is very important

...

Discuss pregnancy dietary needs and give examples of increased needs related to protein, carbohydrates, etc.

Proper nutrition in important throughout a pregnancy. Water soluble vitamins (B complex vitamins), C, thiamine, riboflavin). need to constantly be replaced because the body can't store them. Fat soluble vitamins (A, D, E, and K) are important but are less likely to be deficient because they body can store them for later.

Vitamin B9 (Folic Acid) is important to reduce to risk for neural tube defects (openings in the spine cord or brain). Since many pregnancies are unplanned, t is recommend that all women of child-bearing years take this vitamin.


Pregnancy increases the need for carbohydrates (sugars), fats, and calories. Grains, fruits and vegetables are great sources for carbohydrates. Fish and nuts are great sources for fats. A woman need roughly 400 extra calories per day during the pregnancy (the exact value fluctuates throughout the pregnancy).

Two important minerals to note are iron and calcium. Iron is important for blood formation--both for the mother and the featus. Calcium is important for the formation of bones, and the neuromuscular system.

Amino acids (proteins) are critical as they are the building blocks of life. Meats, fish, fruits, dairy and nuts are high in protein.

Vegetarains should consider protein supplments to ensure that they are getting all of the essential amino acids. They should also consider taking B-Complex vitamins (which include Folic Acid and Niacin) (helps with metabolism and energy) and possibly Zinc (with with cell development and growth) as these nutrients are sparse outside of meat products.

Proper hydration is important, and a pregnant woman should have about eight 8-ounce glasses a day.

What is the primary focus of diagnostic testing during pregnancy? Name 2 common testes performed and why

The primary focus of diagnostic testing during pregnancy is to determine the well-being of a fetus during pregnancy. Two common procedures are an Ultrasound and Amniocentesis. Ultrasound is a procedure that uses high-frequency sound waves to visualize internal organs and tissues. Ultrasound is used to confirm pregnancy, confirm gestation age, identify multiply pregnancies, site of fetal implantation, assess fetal growth and development, assess maternal structure, confirms fetal viability or death, rules out or verifies fetal abnormalities, locates the site of placental attachment, determines amniotic fluid volume, observes fetal movement, placental grading and adjunct for other procedures.

Amniocentesis is a procedure where amniotic fluid is removed from the uterus for testing. Amniotic fluid is the fluid that surrounds the baby during pregnancy. With testing we will be able to determine if the fetus has spina bifida or Down syndrome. The testing will also show if there is incomplete development of the fetal skull and brain. This test can be performed after 14 weeks of gestation. If gestation is less than 37 weeks, a sample of amniotic fluid is tested to determine whether the baby's lungs are mature enough for birth.

Source: ATI RN Maternal Newborn Nursing Edition 8.0 pg. 50-57.

...

A biophysical profile is a prenatal test used to check on a baby's well-being. The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound — an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus. During a biophysical profile, a baby's heart rate, breathing, movements, muscle tone and amniotic fluid level are evaluated and given a score.



Typically, a biophysical profile is recommended for women at risk of pregnancy loss. A biophysical profile is typically done after week 32 of pregnancy.



Your health care provider might recommend a biophysical profile if you have:

•A multiple pregnancy
•An underlying medical condition, such as type 1 diabetes, gestational diabetes, high blood pressure, a blood disorder, lupus, thyroid disease, kidney disease or heart disease
•A pregnancy that has extended two weeks past your due date (postterm pregnancy)
•A history of pregnancy loss
•A baby who has decreased fetal movements or possible fetal growth problems
•Too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios)
•Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby's blood group is Rh positive
•Worrisome results from other prenatal tests

The quad screen is done to evaluate your risk of carrying a baby who has any of the following conditions

:Down syndrome (trisomy 21). Down syndrome is a genetic condition that causes lifelong impairments in mental and social development, as well as various physical concerns.

Edwards syndrome (trisomy 18). Edwards syndrome is a genetic condition that causes severe developmental delays. Edwards syndrome is often fatal by age 1.

Spina bifida. Spina bifida is a serious birth defect that occurs when the tissue surrounding a baby's developing spinal cord doesn't close properly. Spina bifida can lead to severe physical and mental disabilities.

Anencephaly. Anencephaly is an underdeveloped brain and an incomplete skull. A baby born with anencephaly might be stillborn or survive only a few hours to days after birth.

Physiologic Changes

The total blood volume is a combination of plasma, red blood cells, white blood cells, and platelets. The total blood volume increases by 30% - 50% during pregnancy. Increases are even higher in multifetal pregnancies. The increased volume is needed to transport nutrients and oxygen to the placenta so they area availible for the growing fetus and to meet the demands of the expanded maternal tissue in the uterus and breasts. The greater volume also is also needed to protect the mother from adverse effects of blood loss that occurs during childbirth.

Other physiologic changes include:

The increase in blood volume causes an increase in cardiac output.

Peripheral vascular resistance falls during pregnancy

Systolic blood pressure usually remains unchanged or my decrease slighty, while diastolic pressure may decrease by about 10-15 mm Hg by 24-32 weeks of gestation

reccomended weight gain

Recommended weight gain during pregnancy is based on the woman's prepregnancy weight for her height, or her body mass index, (BMI). Recommended weight gain is 25-35 lbs for women who start pregnancy at normal BMI or weight for height. Overweight women should gain between 15-25 lbs, this provides sufficient nutrients for the fetus. Obese women should gain at least 15lbs.

Women who are shorter than 60 inches may not need to gain as much as a taller woman. Young adolescents need to gain the higher amount ( on the range) of weight to provide enough growth for themselves as well as for the fetus.

Obesity in pregnant women is associated ith increased chance of gestational diabetes, preeclampsia, neural tube defects, cesarean birth, and postpartum complications.

Guidlines for weight gain are 3.5lbs the first trimester and 1lb. each week during the second and third trimester

two kind of plecenta issues

Placenta previa occurs when a baby's placenta partially or totally covers the mother's cervix — the doorway between the uterus and the vagina. Placenta previa can cause severe bleeding before or during delivery. The placenta provides oxygen and nutrients to your growing baby and removes waste products from your baby's blood. It attaches to the wall of your uterus, and your baby's umbilical cord arises from it. In most pregnancies, the placenta attaches at the top or side of the uterus. In placenta previa, the placenta attaches to the lower area of the uterus.

If you have placenta previa, you'll probably be restricted to bed rest for a portion of your pregnancy and you'll likely require a caesarean section (C-section) to safely deliver your baby.

Placental abruption (abruptio placentae):

When the placenta peels away from the inner wall of the uterus before delivery, either partially or completely, it's known as placental abruption. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother.

Placental abruption often happens suddenly. Left untreated, placental abruption puts both mother and baby in jeopardy

what causes pain

Placenta abruption causes abdominal and/or lower back pain with bleeding.

Placenta Previa causes painless bleeding

Quickenting

Quickenting refers to the first fetal movement the accurs during the 13-16 week of fetal development. The fetus grows rapidly in length and the head becomes smaller in proportion to the total length, and movements become stronger. Women who have been pregnant before can usually detect the feeling of quickening better then first time pregnancies

Quickenting

The first fetal movements are called quickening and are often described as flutters. It may be difficult to determine whether this feeling is gas or your baby's movements, but soon you will begin to notice a pattern. First-time moms may not feel these movements as early as second-time moms.

Toxoplasmosis

is a protozoal infection caused by Toxoplasma gondii. Infection is transmitted through organisms in raw or undercooked meat, through contact with infected cat feces, or accross the placental barrier to the fetus if the expectant mother acquires the infection during pregnancy. Toxoplasmosis is often subclinical (without clinical manifestations); the woman may experience a few days of fatigue, muscle pains, and swollen glands but may be unaware of the disease. If the infection is suspected, diagnosis can be confirmed by positive serologic test results, which include indirect fluorescent antibody tests for IgG and IgM.

Fetal and Neonatal Effects: The severity of fetal and neonatal effects secondary to toxoplasmosis vary with timing during pregnancy. Transmission of maternal infection to the fetus is highest during the third trimester. However, severe infant effects are more likely when acute infection occures in the first trimester. Severe infant complications may include chorioretinitis, hydrocephaly, microcephaly, and calcifications within the cranium.

Teaching: Women should be advised to use these precautions to avoid infection at anytime.

•Cook meat thoroughly, particularly pork, beef, and lamb.
•Avoid touching mucous membranes of the mouth or eyes while handling raw meat.
•Wash all kitchen surfaces thay come into contact with uncooked meat.
•Wash hands thoroughly after handling raw meat.
•Avoid uncooked eggs and unpasteurized milk.
•Wash fruits and vegetables before eating.
•Avoid contact with materials that are possibly contaminated with cat feces when pregnant (cat litter boxes, sand boxes, garden soil).
Maternal treatment of toxoplasmosis during pregnancy is essential to reduce the risk for congenital infection. Sufonamides can be used alone but are less effective than combination therapy. Spiramycin is successfully used in Europe for maternal toxoplasmosis and may be used under specific guidelines within the United States. Pyrimethamine may be added after the first trimester to reduce the drug's tetrogenic effects.

Group B streptococcus (GBS)

is the leading cause of life-threatening prenatal infections in the U.S. The gram-positive bacterium colonizes the rectum, vagina, cervix, and the urethra of pregnant and nonpregnant women. Symptomatic maternal infections such as urinary tract infection, chorioamnionitis, and endometritis can occur during pregnancy. GBS is associated with preterm rupture of membranes and preterm birth. (Duff,2007;CDC,2002;Gibbs et al.,2004)

Early-onset newborn GBS infection occurs during the 1st week after birth, often within 48 hours. Women who have GBS in the rectovaginal area at the time of birth have a 60% chance of transmitting the organism to their newborn, and about 1% to 2% of these infants will develop early-onset GBS disease. Sepsis, pneumonia, and meningitis are the primary infections in early-onset GBS disease. Late onset occurs after the first week of life and meningitis is the most common manifestation. Gibbs et al., 2004; Savoia, 2004)

Identifying women who are asymptomatic carriers of GBS is difficult because the duration of carrier status varies. Optimal identification of the GBS carrier status is obtained by vaginal and rectal culture between 35 and 37 weeks of gestation. Penicillin is the first-line agent for antibiotic treatment of the infected women during birth. Ampicillin is an acceptable alternative. Women who have clindamycin-and erythromyacin-resistant GBS infections are more often observed than during the past.

Added guidelines based on CDC guidelines in 2002 include:

•Routine intrapartum antibiotic prophylaxis treatment for GBS infection is not required for the woman having a planned cesarean birth if labor or membranes rupture did not preceded her planned cesarean birth.
•A woman whose GBS culture is not known at the time of births managed according to her risk. GBS infection risk is higher if the pregnancy is less than 37 weeks, membrane rupture has persisted 18 hours or more, or temperature is higher than 100.4 F.
•A mother who previously gave birth to an infant with GBS disease or who had bacterial infection with GBS during pregnancy should receive antibiotic prophylaxis at birth.

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